A hysteroscopy is performed by passing a thin, lighted scope through the vagina and cervix into the uterus, where a liquid or gas gently expands the uterine walls so the doctor can see inside. The entire process typically takes 5 to 30 minutes depending on whether it’s purely diagnostic or involves a treatment like removing a polyp or fibroid. Many diagnostic hysteroscopies happen in a doctor’s office rather than an operating room.
Why a Hysteroscopy Is Done
Doctors recommend hysteroscopy to investigate or treat problems inside the uterus. Common reasons include abnormal bleeding, unusually heavy periods, bleeding after menopause, suspected polyps or fibroids, scar tissue (adhesions), or an irregularly shaped uterus. It’s also used to locate a displaced IUD, take a tissue sample for biopsy, or evaluate fertility issues. The procedure gives a direct, real-time view of the uterine lining, which imaging tests like ultrasound can’t always match in detail.
Office Setting vs. Operating Room
Diagnostic hysteroscopies and some minor treatments can be done right in a gynecologist’s office. A 2025 systematic review found that office-based hysteroscopy has a procedure completion rate of about 95%, with average pain scores around 3.5 out of 10. Patients consistently reported high satisfaction, shorter procedure times, and faster recovery compared to operating-room procedures.
More complex cases, such as removing large fibroids or extensive scar tissue, are typically performed in a hospital or surgical center. These require general or regional anesthesia and involve longer recovery because of the anesthesia itself and the more involved surgical work.
Preparing Before the Procedure
Your doctor may schedule the hysteroscopy during the first half of your menstrual cycle, when the uterine lining is thinnest and easiest to examine. In some cases, a medication is placed in the vagina a few hours beforehand to soften and slightly open the cervix, making insertion easier. Misoprostol is the most commonly used agent for this, typically given about three hours before the procedure.
Taking an over-the-counter anti-inflammatory pain reliever (like ibuprofen) before you arrive can reduce cramping during and after the procedure. A large review of pain management strategies found that NSAIDs had the strongest evidence for reducing hysteroscopy-related discomfort, outperforming other options with fewer side effects.
Step by Step: What Happens During the Procedure
The process follows a predictable sequence, though the details vary based on whether it’s diagnostic or operative.
Positioning and Anesthesia
You lie on an exam table with your feet in stirrups, similar to a pelvic exam. For an office-based diagnostic procedure, you may receive no anesthesia at all, or a local anesthetic applied to the cervix. For operative hysteroscopy in a surgical center, you’ll typically receive general anesthesia (fully asleep) or regional anesthesia (numb from the waist down).
Inserting the Hysteroscope
The hysteroscope is a slim tube, usually between 3 and 5 millimeters in diameter. To put that in perspective, that’s roughly the width of a pencil or slightly less. Scopes come in rigid and flexible varieties. Flexible hysteroscopes can bend to navigate curves, while rigid scopes provide a crisper image and are more common for operative work.
In many modern practices, doctors use a technique called vaginoscopy: the hysteroscope is gently guided into the vagina without a speculum (the metal instrument used in a standard pelvic exam) or any clamping of the cervix. This approach tends to be more comfortable. The scope is advanced through the cervical canal and into the uterine cavity.
Expanding the Uterus
The uterus is normally a collapsed space, so the walls need to be pushed apart for the camera to see anything. A fluid, most often normal saline, is pumped through the hysteroscope to inflate the uterine cavity. For diagnostic-only procedures, carbon dioxide gas can be used instead. The distension creates a clear view of the uterine lining, the openings of the fallopian tubes, and any abnormalities like polyps, fibroids, or adhesions. This filling sensation is what causes the cramping most patients feel.
Examining or Treating
During a diagnostic hysteroscopy, the doctor surveys the entire cavity and may take a small tissue biopsy. The camera transmits a magnified image to a monitor, allowing detailed inspection of the lining.
If the procedure is operative, small instruments are passed through a working channel built into the hysteroscope. For polyp or fibroid removal, a resectoscope (a specialized instrument with an electrosurgical wire loop) can shave or cut away tissue from inside the uterus. The same channel can be used to place instruments that cut through scar tissue or remove a lost IUD. Everything is done under direct camera visualization, so the doctor can see exactly what’s being treated.
Completing the Procedure
Once the examination or treatment is finished, the fluid is drained, the hysteroscope is withdrawn, and the procedure is over. No incisions are made and no stitches are needed, since the scope enters through the body’s natural opening.
What It Feels Like
During an office-based procedure without general anesthesia, most people feel pressure and cramping as the hysteroscope passes through the cervix and the uterus is expanded with fluid. The sensation is often compared to strong menstrual cramps. Pain levels vary from person to person, but the average reported score in large studies is moderate, around 3.5 on a 0-to-10 scale. The most intense discomfort usually lasts only a minute or two during the cervical entry and uterine distension, then eases. If the procedure is done under general anesthesia, you won’t feel anything during it but may wake up with mild cramping.
Recovery After Hysteroscopy
Recovery is fast for most people. You can typically return to normal activities within one to two days. Many people go back to work the day after the procedure, though this depends on what was done and the physical demands of your job. Some light spotting or watery discharge is normal for a few days as residual fluid drains.
Cramping after the procedure responds well to the same over-the-counter anti-inflammatory medications used beforehand. If the hysteroscopy was operative and involved tissue removal, your doctor will give you specific guidance on when you can resume sexual activity and exercise, as healing times vary based on the extent of the treatment.
Risks and Complications
Hysteroscopy is considered a low-risk procedure. The most common issue is mild cramping or spotting that resolves on its own. Serious complications are uncommon but can include uterine perforation (the scope or an instrument puncturing the uterine wall), infection, or problems related to excess fluid absorption during longer operative procedures. The risk profile is significantly lower for diagnostic hysteroscopy than for operative cases, since no cutting or tissue removal is involved. Signs that something may be wrong afterward include heavy bleeding, fever, or worsening pain over the days following the procedure rather than improving.